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Published on: December 20, 2011
Parental Assessment of Postsurgical Pain in Infants at Home Using Artificial Intelligence-Enabled and Observer-Based
Fatos Sada1, Paola Chivers2,3,4, Sokol Cecelia1,5
1Faculty of Medicine, University of Prishtina, Prishtina, Kosovo.
Insights
Parents effectively used standardized tools like PainChek Infant and Observer-Administered Visual Analog Scale (ObsVAS) to manage infant pain at home post-surgery. Interventions, including feeding and medication, successfully reduced pain in most cases.
Area of Science:
- Pediatrics
- Pain Management
- Health Informatics
Background:
- Infant pain assessment is challenging due to non-verbal communication.
- Limited data exists on parental home-based pain management using standardized tools.
Purpose of the Study:
- To explore parental assessment and intervention of infant pain at home after same-day surgery.
- To evaluate standardized pain assessment tools for home use.
Main Methods:
- Prospective study of 109 infants undergoing circumcision.
- Parents used PainChek Infant (iOS) or ObsVAS (Android) for 3 days post-surgery.
- Statistical analyses included Chi-square, GEE, and ROC analysis.
Main Results:
- 69 parents completed diaries; 45 used PainChek Infant, 24 used ObsVAS.
- Feeding (alone or with medication) was the primary intervention.
- Interventions significantly reduced pain, with medicinal interventions being most effective.
- PainChek Infant showed higher likelihood of reporting pain reduction.
Conclusions:
- Standardized tools empower parents in infant pain management at home.
- PainChek Infant and ObsVAS demonstrated construct validity and clinical utility.
- Feeding and medication were key parental pain intervention strategies.
Background:
Pain assessment in the infant population is challenging owing to their inability to verbalize and hence self-report pain. Currently, there is a paucity of data on how parents identify and manage this pain at home using standardized pain assessment tools.
Objective:
This study aimed to explore parents' assessment and intervention of pain in their infants at home following same-day surgery, using standardized pain assessment tools.
Methods:
This prospective study initially recruited 109 infant boys undergoing circumcision (same-day surgery). To assess pain at home over 3 days after surgery, parents using iOS devices were assigned to use the PainChek Infant tool, which is a point-of-care artificial intelligence-enabled tool, while parents using Android devices were assigned to use the Observer-Administered Visual Analog Scale (ObsVAS) tool. Chi-square analysis compared the intervention undertaken and pain presence. Generalized estimating equations were used to evaluate outcomes related to construct validity and clinical utility. Receiver operating characteristic analysis assessed pain score cutoffs in relation to the intervention used.
Results:
A total of 69 parents completed postsurgery pain assessments at home and returned their pain diaries. Of these 69 parents, 24 used ObsVAS and 45 used PainChek Infant. Feeding alone and feeding with medication were the most common pain interventions. Pain presence over time reduced. In the presence of pain, an intervention was likely to be administered (χ22=21.4; P<.001), with a medicinal intervention being 12.6 (95% CI 4.3-37.0; P<.001) times more likely and a nonmedicinal intervention being 5.2 (95% CI 1.8-14.6; P=.002) times more likely than no intervention. In the presence of intervention, score cutoff values were ≥2 for PainChek Infant and ≥20 for ObsVAS. A significant effect between the use of the pain instrument (χ21=7.2, P=.007) and intervention (χ22=43.4, P<.001) was found, supporting the construct validity of both instruments. Standardized pain scores were the highest when a medicinal intervention was undertaken (estimated marginal mean [EMM]=34.2%), followed by a nonmedicinal intervention (EMM=23.5%) and no intervention (EMM=11.2%). Similar trends were seen for both pain instruments. Pain was reduced in 94.5% (224/237) of assessments where parents undertook an intervention. In 75.1% (178/237) of assessments indicative of pain, the score changed from pain to no pain, with PainChek Infant assessments more likely to report this change (odds ratio 4.1, 95% CI 1.4-12.3) compared with ObsVAS assessments.
Conclusions:
The use of standardized pain assessment instruments by parents at home to assess pain in their infants can inform their decision-making regarding pain identification and management, including determining the effectiveness of the chosen intervention. In addition to the construct validity and clinical utility of PainChek Infant and ObsVAS in this setting, feeding alone and a combination of feeding with medication use were the key pain intervention strategies used by parents.
